Lateral versus Subxiphoid Thoracoscopic Thymectomy For Non-Thymomatous Myasthenia Gravis

Background: VATS thymectomy, performed using the intercostal approach (LVATS), is the most widely used minimally invasive surgical treatment for thymus surgery worldwide. Subxiphoid single-port thoracoscopic thymectomy (SVATS) is a recent alternative approach to LVATS.Methods: Between May 2019 and February 2023, 60 patients with non-thymomatous myasthenia gravis were enrolled in this prospective study. Patients were randomly divided into two groups: (the LVATS group and the SVATS group); each group contained 30 patients. The mean operative time, blood loss, conversion to open thymectomy, duration of postoperative pleural drain, total length of hospital stay, and postoperative complications were evaluated.Results: The mean age was 37.3±5.61 in the LVATS group, while it was 39.7±6.39 in the SVATS group. The mean operating times were 94.66±14.31 minutes in the LVATS group and 90.56±10.80 minutes in the SVATS group, with no significant difference observed (p=0.227). The LVATS group had a significant drop in hemoglobin level (1.86±0.77 gm%) compared to the SVATS group (1.31±0.46 gm%) (p=0.014). The mean duration of chest drains was significantly longer in the LVATS group (2.03±0.18 days) compared to the SVATS group (1.70±0.46 days)(p=0.001). The mean duration of postoperative pain was significantly longer in the LVATS group (8.36±0.80 days) compared to the SVATS group (6.16±1.14 days)(p=0.018). The mean total length of hospital stay was significantly longer in the LVATS group (12.46±0.73days) compared to the SVATS group (11.06±0.58 days)(p=0.003).Conclusion: Both LVATS and SVATS are safe and effective procedures for treatment of non-thymomatous myasthenia gravis. SVATS provides less intraoperative blood loss and a shorter duration of pleural drain, hospital stay, and postoperative pain.